Background. Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method. We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016–2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results. Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, ) and diabetes (24.5% vs. 15.2%, ). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, ); the onset to first medical contact (FMC) (255 vs. 190 minutes, ), onset to fibrinolysis (218 vs. 185 minutes, ), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, ) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, ), death or treatment withdrawal (14.5% vs. 5.6%, ), and MACCE (18.5% vs. 9.4%, ) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12–2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26–2.24), and MACCE (OR: 1.37, 95% CI: 1.08–1.74) after adjustment for covariates. Among possible explanatory factors, age (−58.46%, −59.04%, −62.20%) and cardiovascular risk factors (−40.77%, −39.36%, −41.73%) accounted for most of the gender-associated risk differences. Conclusions. Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.

中文翻译：

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ST 段抬高型心肌梗死患者的特征、管理和住院结局的性别差异：来自河南 STEMI 登记处的见解

背景。因 ST 段抬高心肌梗死 (STEMI) 住院的女性比男性的早期死亡风险更高。我们旨在调查风险因素、临床特征和管理对性别相关风险差异的潜在影响。方法。我们分析了 2016-2018 年间从 66 家医院前瞻性纳入的 5063 名 STEMI 患者，并在对协变量进行连续调整后，使用广义线性混合模型比较了死亡率、死亡或治疗退出以及主要不良心脑血管事件 (MACCE) 的性别差异。结果。女性年龄较大，高血压患病率较高（53.3% vs. 41.1%，)和糖尿病 (24.5% vs. 15.2%,）。符合条件的女性接受再灌注治疗的可能性较小（56.1% vs. 62.4%，); 从第一次医疗接触 (FMC) 开始（255 分钟对比 190 分钟，)，纤维蛋白溶解开始（218 分钟对 185 分钟，)，并开始经皮冠状动脉介入治疗 (PCI)（307 分钟 vs. 243 分钟，)在女性中显着延迟。院内死亡的发生率（6.8% vs. 3.0%，)、死亡或治疗退出（14.5% 对 5.6%，)和 MACCE (18.5% 对 9.4%,)明显更高。性别差异持续存在于死亡（OR：1.61，95% CI：1.12-2.33）、死亡或治疗退出（OR：1.68，95% CI：1.26-2.24）和MACCE（OR：1.37，95% CI：1.08） –1.74) 调整协变量后。在可能的解释因素中，年龄（-58.46%、-59.04%、-62.20%）和心血管危险因素（-40.77%、-39.36%、-41.73%）占性别相关风险差异的大部分。结论。女性的住院结局更差，年龄和心血管危险因素是影响性别差异的主要因素。性别差异强调了临床实践中针对女性患者的质量改进工作的意识和重要性。